Experiences of People With Dementia in Pakistan: Help-Seeking, Understanding, Stigma, and Religion

The impact of cultural practice and policy on dementia care in Nepal

BACKGROUND

People's wider culture plays a vital role in both dementia care and policy. This study aims to explore the cultural practice and policy influence around caring for People Living with Dementia (PLWD) in Nepal.

METHODS

An exploratory qualitative study was designed to investigate dementia care in Nepal. The study comprised four in-depth interviews and four focus group discussions with 29 participants, including family members, health care professionals, and other stakeholders. Data were analysed using thematic analysis.

RESULT

Four major themes (each with several sub-themes) were identified: (1) Cultural practice in dementia care; (2) Impact of policy on the dementia care; (3) Service provision; and (4) Education and training.

CONCLUSION

There is a need for community-based awareness raising on dementia and its care, to sensitise all relevant stakeholders to meet the needs of PLWD. In addition, capacity building of health workforce is needed to enhance their knowledge of and skills in providing culturally appropriate dementia care.

Experiences of caregivers of people with dementia in Indonesia: A focus group study

BACKGROUND

Many people with dementia are reliant on family caregivers to provide daily care to maintain quality of life and dignity. As a result, caregivers can experience increased burden, poorer health outcomes and increased stigma. To date, the experiences of caregivers of people with dementia has not been explored within an Indonesian context.

AIMS

This study aims to understand the experience of caregivers of people with dementia in Indonesia and better understanding of the stigma associated with dementia.

MATERIALS AND METHODS

This qualitative study is embedded within the Strengthening Responses to Dementia in Developing Countries project. Focus Group Discussions were held with dementia caregivers residing in Jakarta, Indonesia. Inductive thematic analysis was used to analyse the transcripts.

RESULTS

Nineteen caregivers of people with dementia participated in the Focus Group Discussions. Themes identified included: (1) Understanding of dementia, (2) Reaction to care, and (3) Seeking a diagnosis.

DISCUSSION

A perceived lack of understanding about dementia amongst the caregivers, ultimately shaped caregivers experience of care. This included negative reactions to care leading to internalised stigma (e.g., fear and shame). Misconceptions that dementia was due to spiritual and mystical reasons were particularly stigmatising.

CONCLUSION

In Indonesia, families are providing care to people with dementia in an environment in which there is a lack of understanding that can lead to misdiagnosis, feelings of fear and shame. Efforts to raise address stigma and misunderstanding among the general public and healthcare professionals could be of particular value to support people with dementia and reduce the fear and shame that they can experience.

"Now at least we have something to call it": Patient and care partner experiences receiving an amyloid PET scan

BACKGROUND

The primary objective of this paper was to examine perspectives and experiences of individuals with cognitive impairment who received an amyloid PET scan and their care partners, with regard to the process, logistics, and decision-making associated with receiving an amyloid PET scan and its results.

METHODS

Structured telephone interviews were conducted with 200 randomly sampled scan recipient/care partner dyads from the CARE IDEAS study. The audio-recorded, transcribed responses were analyzed using an inductive qualitative content analytic approach.

RESULTS

Participating individuals and care partners described their experiences in seeking a diagnosis for memory issues, including decision-making and logistics involved with receiving an amyloid PET scan. Participants discussed the factors contributing to their decision to seek a diagnosis for their memory issues and their hopes and expectations in completing the scan. Participants also described the trajectory of this process, and although some described relatively straightforward trajectories, others described problems associated with identifying appropriate providers and coordinating care across numerous providers to obtain a diagnosis for their memory issues. Participants described an additional challenge of physicians attributing cognitive decline to normal aging, rather than signs of a neurodegenerative disorder.

CONCLUSIONS

Findings shed light on the barriers and delays that individuals and care partners experience in connecting with physicians and obtaining a comprehensive evaluation for cognitive problems. Results from this study have implications for physicians who provide care to older adults, and specifically highlight the need for greater care coordination and clearer communication with and systems of referral for patients.

Mental Health Survey of Social Entrepreneurs During COVID-19: A Study From Pakistan

Background

COVID-19 is widely considered one of the worst pandemics in history, resulting in worldwide lockdowns, social isolation, unemployment, and economic recession. With the prolongation of COVID-19, numerous people experience stress, depression, and other mental health challenges. Recently, several studies have been documented in the literature on mental health issues among students (related to medical or other fields), teachers, medical personnel, and nurses in the wake of the COVID-19 pandemic. However, social entrepreneurs (SEs) have received insufficient attention. This study aims to conduct an online survey in Pakistan's five major cities to investigate more about the mental health status of social entrepreneurs.

Materials and Methods

An online survey which included the Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7) was employed to collect data. The data analyses were carried out employing descriptive statistics, chi-square test, and multiple regression analyses.

Results

A total of 840 social entrepreneurs from Pakistan participated in the survey. Among these, 366 (43.6%) were female and 474 (56.4%) were male. The findings revealed that 709 (84%) social entrepreneurs were suffering from depression symptoms, and 600 (80%) were suffering from anxiety symptoms. The majority of social entrepreneurs with depression (N = 546) and anxiety (N = 567) had mild and moderate stages. In addition, optional open-ended questions were asked from SE participants that help to understand their perception and response to the COVID-19 pandemic.

Conclusion

The study concluded that several SEs in major cities of Pakistan were experiencing depression and anxiety symptoms. Based on data analysis, male SEs were highly suffering from depression and anxiety than female SEs. Limited resources and changes in customers' behavior were one of the major problems that lead SEs to depression and anxiety during the COVID-19 epidemic. In addition, SEs revealed that the lack of a social business execution policy is the most distressing factor for them. Therefore, a local government must take rigorous precautionary measures to prevent mental health issues among social entrepreneurs. Moreover, the Government of Pakistan needs to adopt supportive policies to assist social entrepreneurs in stressful circumstances.

Subjective Experiences of Alzheimer's Disease in the Pakistani Cultural Context: An Exploratory Study

Studying Alzheimer's disease with the fluctuating environmental, individual, and cultural factors in pertinence to the Diagnostic Statistical Manual (DSM-5) requires information, awareness, and understanding of the disease. Studies have calibrated sociocultural factors to be imperative in the expression of functional symptomology of Alzheimer's disease. Pakistan as a sociocentric, predominantly Muslim country, calls for such efforts. The current research was conducted to study the functional symptomology and experiences of Alzheimer's disease. A qualitative approach was adopted in which in-depth interviews of three dyads of patients with Alzheimer's disease and their caregivers (N = 6) were conducted. Interpretative Phenomenological Analysis was applied to acquire the thematic analysis of data. Results showed sociocentricism as a forefront factor. Cognition, behavior, and emotions were found to be functionally expressed by religion, unawareness, respect of older people, stigmatization, and isolation within family dynamics. The study could be an instigator for further culture-oriented assessment and management providing services.

The Experience of Lived Time in People with Dementia: A Systematic Meta-Synthesis

INTRODUCTION

For people with dementia, lived time is important to understand, as the condition affects memory, perceptions of time, and life expectancy. The aim of this study was to locate, interpret, and synthesize the experience of lived time for people with dementia.

METHOD

This article presents a qualitative systematic meta-synthesis. The theoretical framework of lifeworlds by van Manen provided the context for the study. The Critical Appraisal Skills Programme criteria for qualitative studies were used to appraise the studies. Sixty-one qualitative research studies based on interviews with people with dementia were included in the review. The analysis followed the principles of interpretive synthesis.

RESULTS

Four categories were revealed: (1) rooted in the past - "I am the same as before"; (2) focussing on the present - "Nobody has tomorrow"; (3) thinking about the future - "What is going to happen to me?"; and (4) changes in the experience of self over time - "I used to…." The latent overall meaning was expressed as "being engaged with the dimensions of time."

DISCUSSION/CONCLUSION

The experience of lived time is an active and important one, enabling people to manage the dementia journey. Future work involving people with dementia should foreground the experience of lived time.

Muslims' Affective and Cognitive Attitudes towards Formal Dementia Care in South Africa: Do They Vary according to Family Structure and the Experience of Familial Caregiving?

BACKGROUND

The feelings and beliefs of some social groups sharing the same values about formal care institutions impacts their likelihood of using such services. Socialisation theory posits that there should not be any difference in attitudes towards formal care in the Muslim community, as they are influenced by the principles of Confucianism. However, demographic, epistemological, and socio-economic trends, as well as globalisation, may be impacting the efficacy of caring for people with dementia (PWD) at home.

OBJECTIVE

This study examines the affective and cognitive attitudes of South African Muslims towards formal care, and whether they vary according to family structure and experience with informal dementia care.

METHODS

We conducted a survey, administered in the form of an online questionnaire, of Muslim families across each of the 9 provinces of South Africa. The topics addressed included the demographics of the respondents, whether they had experience with informal dementia care, the structure of their family, and affective and cognitive attitudinal variables.

RESULTS

422 responses were analysed, with the results demonstrating negative attitudes across family structures and experience with informal dementia care. This indicates that the changes brought about by economic development and globalisation are not impacting the social influence of the Islam religion towards caregiving.

CONCLUSION

With up to 90% of PWD moving into formal care before they die in some countries, governments and other service providers of formal care need to provide culturally congruent care. There is also a need to build relationships with minority social groups that are not cared for by geriatric service organisations (governmental and non-governmental) in order to break down the negative attitudes that families have about formal care, and provide the families caring for PWD at home with coping strategies and support programmes to enhance the caregiving experience.

Demographic Characteristics Associated with the Likelihood to Use Paid Home Care for People with Dementia among South African Muslims

BACKGROUND

In societies where the value of filial piety is observed, a preference for caregiving to take place at home exists. In fact, institutional and paid home care for people with dementia (PWD) are still taboo in some Muslim societies. However, economic development and globalisation have resulted in intergenerational separation, thus impacting the ability by young adults to provide care for the elderly at home.

OBJECTIVE

We establish the demographic characteristics most likely to be associated with the use of paid home care - age, gender, education level, marital status, family structure, experience with dementia care in the family, and number of dependents - for PWD among South African Muslims.

METHODS

A survey, administered in the form of an online questionnaire, of Muslim families across each of the 9 provinces of South Africa was conducted. Multiple logistic regression was used to test the effects of the demographic variables on the type of care choice arrangement (family as primary caregiver vs. paid home caregiving).

RESULTS

422 responses were analysed, 28% of which indicated the respondents' desire to use paid home caregivers. The multiple logistic regression results indicate that South African Muslim families are more likely to use paid home care if they are older (that is, over 40 years; OR = 1.972, 95% CI: 1.445-2.695), are female (OR = 1.637, 95% CI: 1.089-2.457), and have high levels of education (OR = 1.828, 95% CI: 1.070-3.125).

CONCLUSION

Home-based care is touted as the next dementia care model. Given that intergenerational mobility is likely to increase as future generations continue to participate more in the labour market, minority groups with a disposition to the same familial social values will require appropriate support in order to cope with the demands of caring for PWD. Suitable interventions for Muslim families who are not open to using external assistance, as well as those who are, need to be administered to enable the caregiver and care recipient to thrive at home.

Relationship between Knowledge and Types of Attitudes towards People Living with Dementia

The purpose of this study was to examine the relationship between knowledge and attitudes towards dementia among adults. A cross-sectional online survey with purposive sampling was conducted in four district health centers in Taichung, Taiwan, in 2018. Knowledge was measured by the Taiwanese version of the Dementia Knowledge Assessment Scale. Attitudes towards people with dementia were measured by four kinds of feelings: discomfort, shame, avoidance, and fear. In total, 347 persons completed the questionnaire. Knowledge of dementia was modest. Higher education, a care-related background, chronic health conditions, experience caring for people with dementia, and knowledge of family history were related to higher knowledge of dementia. Attitudes towards people with dementia were grouped into four clusters: uncomfortable (22.2%), ashamed (2.6%), unfriendly (22.5%), and non-negative (52.7%). Knowledge of dementia was significantly related to the ashamed cluster but not to the other clusters. Lower education, a lack of caring experience, and a lack of knowledge of family history were related to uncomfortable feelings, and poorer financial satisfaction was related to uncomfortable, afraid, and avoidant feelings. The open-question expression of feelings towards dementia was more likely to be negative (55.3%). The public should be educated on knowledge of and friendly attitudes towards dementia.

Attitudes, knowledge and beliefs about dementia: focus group discussions with Pakistani adults in Karachi and Lahore

Pakistan is a lower middle-income country, which to date has had very little research and policy making to address the challenge of dementia. This study aims to explore the perceptions of dementia in a group of Pakistani adults. A series of focus group discussions were completed during 2017 with men and women in two metropolitan centres in Pakistan (Lahore and Karachi) (N = 40). Two vignettes, depicting someone with mild dementia and someone with severe dementia, were used to facilitate discussions. An induction-led thematic analysis was completed. Five themes were identified, reflecting (a) dementia awareness, (b) responsibility, (c) barriers to health care, (d) identified support needs, and (e) religion. Most participants had little awareness and knowledge about dementia, commonly understood to be a disease of forgetting or just normal ageing. Thus, there is an urgent need of a nation-wide campaign to raise dementia awareness in Pakistan, though this needs to be accompanied by improved, accessible health and social care services.